<div style="margin:4px;padding:4px;">
	<form class="form-horizontal" role="form" style="margin:10px;" id="form_add">
		<div class="form-group">
			<label class="col-sm-2 control-label">姓名：</label>
			<div class="col-sm-10">
				<input type="text" class="form-control input-sm" name="input_1" placeholder="">
			</div>
		</div>
		<div class="form-group">
			<label class="col-sm-2 control-label">身份证号：</label>
			<div class="col-sm-10">
				<input type="text" class="form-control input-sm" name="input_2" placeholder="">
			</div>
		</div>
		<div class="form-group">
			<label class="col-sm-2 control-label">预约号：</label>
			<div class="col-sm-10">
				<input type="text" class="form-control input-sm" name="input_3" placeholder="">
			</div>
		</div>
		<div class="form-group">
			<label class="col-sm-2 control-label">缴存办事处：</label>
			<div class="col-sm-10">
				<input type="text" class="form-control input-sm" name="input_4" placeholder="">
			</div>
		</div>

		<div class="form-group">
			<label class="col-sm-2 control-label">业务类型：</label>
			<div class="col-sm-10">
				<select class="form-control input-sm" name="select_1">
					<option value="0">购买自住房</option>
				</select>
			</div>
		</div>

		<div class="form-group">
			<label class="col-sm-2 control-label">预约时间：</label>
			<div class="col-sm-10">
				<input type="text" class="form-control input-sm Wdate" name="input_5"
					   placeholder="" onClick="WdatePicker()"/>
			</div>
		</div>
		<div class="form-group">
			<label class="col-sm-2 control-label">办理时间：</label>
			<div class="col-sm-10">
				<input type="text" class="form-control input-sm Wdate" name="input_6"
					   placeholder="" onClick="WdatePicker()"/>
			</div>
		</div>
		<div class="form-group">
			<label class="col-sm-2 control-label">预约渠道：</label>
			<div class="col-sm-10">
				<input type="text" class="form-control input-sm" name="input_7" placeholder="">
			</div>
		</div>

		<div class="form-group">
			<label class="col-sm-2 control-label">业务状态：</label>
			<div class="col-sm-10">
				<select class="form-control input-sm" name="select_2">
					<option value="0">待到中心办理</option>
				</select>
			</div>
		</div>

	</form>
</div>



